Hypothesis
Neurocardiogenic syncope: a model for SIDS
a Department
of Paediatrics, Rotunda Hospital and The Children's Hospital, Temple
Street, Dublin l, Republic of Ireland, b Department of Paediatrics, Castlebar General
Hospital, Castlebar, Co Mayo, Republic of Ireland
Correspondence to: Professor Matthews.
Accepted 31 December 1997
A 51/2 month old male infant who had suffered three
acute life threatening episodes was admitted for overnight sleep
studies but was found dead after their completion while still in
hospital. A necropsy classified the cause of death as sudden infant
death syndrome (SIDS). The sleep studies had shown no periods of apnoea (> 20 seconds) or bradycardia (< 90 beats/min), and a rapid
response to nasal occlusion (5 seconds). However, autonomic function
during sleep was poor, with reduced heart rate variability (6 beats/min v control 24 beats/min, SD 6.2) and postural hypotension
(a 12-14% fall in resting systolic blood pressure) associated with a
fall in heart rate when tilted to a vertical position. Postural
hypotension with bradycardia occurs in adults with unexplained syncopal
episodes and is called a neurocardiac reflex. It involves poor
vasomotor tone with peripheral pooling of blood, a consequent reduction in central venous return and cardiac distension, and in some
individuals a neurally mediated bradycardia, as seen in this infant,
rather than the expected tachycardia. A progressive bradycardia is the predominant mechanism of death seen in SIDS infants dying on
cardiorespiratory monitors at home. This case suggests that a
neurocardiac reflex occurs in infants, may have been involved in this
infant's death, and deserves further study in the context of SIDS.
© 1998 by Archives of Disease in Childhood
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
This article has been cited by other articles:
-
Yiallourou, S R, Walker, A M, Horne, R S C
(2008). Effects of sleeping position on development of infant cardiovascular control. Arch. Dis. Child.
93: 868-872
[Abstract] [Full Text] -
Todd, E. S., Scott, N. M., Weese-Mayer, D. E., Weinberg, S. M., Berry-Kravis, E. M., Silvestri, J. M., Kenny, A. S., Hauptman, S. A., Zhou, L., Marazita, M. L.
(2006). Characterization of Dermatoglyphics in PHOX2B-Confirmed Congenital Central Hypoventilation Syndrome. Pediatrics
118: e408-e414
[Abstract] [Full Text] -
Chen, R. V., Perlman, J.
(2006). Sudden Cardiac Arrest in an Intubated Premature Infant With Cerebellar and Brainstem Injury: Is There a Link?. Pediatrics
117: 1814-1817
[Abstract] [Full Text] -
Henderson, L. A., Macey, P. M., Richard, C. A., Runquist, M. L., Harper, R. M.
(2004). Functional magnetic resonance imaging during hypotension in the developing animal. J. Appl. Physiol.
97: 2248-2257
[Abstract] [Full Text] -
Harrington, C., Kirjavainen, T., Teng, A., Sullivan, C. E.
(2002). Altered Autonomic Function and Reduced Arousability in Apparent Life-Threatening Event Infants with Obstructive Sleep Apnea. Am. J. Respir. Crit. Care Med.
165: 1048-1054
[Abstract] [Full Text] -
Harrington, C., Kirjavainen, T., Teng, A., Sullivan, C. E.
(2001). Cardiovascular responses to three simple, provocative tests of autonomic activity in sleeping infants. J. Appl. Physiol.
91: 561-568
[Abstract] [Full Text] -
Chong, A., Murphy, N., Matthews, T.
(2000). Effect of prone sleeping on circulatory control in infants. Arch. Dis. Child.
82: 253-256
[Abstract] [Full Text]
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in ADC Online
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Topic Collections
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
